|
Blood Urea Nitrogen
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$17.38
|
|
|
Blood volume removed from patient
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
4125565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$469.69 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$174.75
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Blood volume removed from patient
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
4125565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Blood Volume Removed from Patient
|
Facility
OP
|
$275.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
4582615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$469.69 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.00
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$206.25
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
Blood Volume Removed from Patient
|
Facility
IP
|
$275.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
4582615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
BLUEBAG BODYFIX 14 REC 700X1825MM/ 50L P10104-823
|
Facility
OP
|
$4,672.00
|
|
| Hospital Charge Code |
5248762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,308.16 |
| Max. Negotiated Rate |
$18,688.00 |
| Rate for Payer: Aetna Commercial |
$4,204.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,308.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,036.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,336.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,242.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,476.16
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cigna Commercial |
$4,298.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,614.45
|
| Rate for Payer: Health EOS Commercial |
$4,158.08
|
| Rate for Payer: HFN Commercial |
$4,298.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,504.00
|
| Rate for Payer: Multiplan Commercial |
$3,737.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,803.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,298.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.28
|
| Rate for Payer: Quartz Commercial |
$3,036.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,803.20
|
| Rate for Payer: The Alliance Commercial |
$18,688.00
|
| Rate for Payer: WEA Trust Commercial |
$2,569.60
|
| Rate for Payer: WPS Commercial |
$3,460.55
|
|
|
BLUEBAG BODYFIX 14 REC 700X1825MM/ 50L P10104-823
|
Facility
IP
|
$4,672.00
|
|
| Hospital Charge Code |
5248762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,289.28 |
| Max. Negotiated Rate |
$4,298.24 |
| Rate for Payer: Aetna Commercial |
$4,204.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,476.16
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cigna Commercial |
$4,298.24
|
| Rate for Payer: Health EOS Commercial |
$4,158.08
|
| Rate for Payer: HFN Commercial |
$4,298.24
|
| Rate for Payer: Multiplan Commercial |
$3,737.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,803.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,298.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.28
|
| Rate for Payer: Quartz Commercial |
$2,803.20
|
| Rate for Payer: WEA Trust Commercial |
$2,569.60
|
| Rate for Payer: WPS Commercial |
$3,460.55
|
|
|
Blue (prong O.D.: 3.5mm) - RAM Cannula
|
Facility
IP
|
$223.00
|
|
| Hospital Charge Code |
5983676
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Blue (prong O.D.: 3.5mm) - RAM Cannula
|
Facility
OP
|
$223.00
|
|
| Hospital Charge Code |
5983676
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
BLUNT PIN 5MM X 150MM 5020-7-150
|
Facility
IP
|
$1,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.65 |
| Max. Negotiated Rate |
$1,182.20 |
| Rate for Payer: Aetna Commercial |
$1,156.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.05
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,182.20
|
| Rate for Payer: Health EOS Commercial |
$1,143.65
|
| Rate for Payer: HFN Commercial |
$1,182.20
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: NAPHCARE Commercial |
$771.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,182.20
|
| Rate for Payer: Quartz Beloit One Network |
$629.65
|
| Rate for Payer: Quartz Commercial |
$771.00
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: WPS Commercial |
$951.80
|
|
|
BLUNT PIN 5MM X 150MM 5020-7-150
|
Facility
OP
|
$1,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$1,182.20 |
| Rate for Payer: Aetna Commercial |
$1,156.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.10
|
| Rate for Payer: Aetna Managed Medicare |
$359.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$835.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$642.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.05
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,182.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$719.09
|
| Rate for Payer: Health EOS Commercial |
$1,143.65
|
| Rate for Payer: HFN Commercial |
$1,182.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$963.75
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: NAPHCARE Commercial |
$771.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,182.20
|
| Rate for Payer: Quartz Beloit One Network |
$629.65
|
| Rate for Payer: Quartz Commercial |
$835.25
|
| Rate for Payer: Quartz Medicare Advantage |
$771.00
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: WPS Commercial |
$951.80
|
|
|
BO AG ID Patient
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
975765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$1,332.30 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicaid |
$3.96
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.96
|
| Rate for Payer: Dean Health Medicaid |
$3.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicaid |
$4.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.96
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$139.75
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare Medicaid |
$3.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$161.25
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WMAP Medicaid |
$3.96
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
BO AG ID Patient
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
975765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$197.80 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
BO AG ID Unit
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
975766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$1,332.30 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicaid |
$5.37
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.37
|
| Rate for Payer: Dean Health Medicaid |
$5.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicaid |
$5.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.37
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare Medicaid |
$5.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WMAP Medicaid |
$5.37
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
BO AG ID Unit
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
975766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
BO Antibody Adsorption
|
Facility
OP
|
$645.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
975763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$419.25
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$483.75
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
BO Antibody Adsorption
|
Facility
IP
|
$645.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
975763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$316.05 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$387.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
BO Antibody ID
|
Facility
IP
|
$286.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
975764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
BO Antibody ID
|
Facility
OP
|
$286.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
975764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$1,332.30 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$214.50
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
BO Antibody Screen
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
975767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicaid |
$5.38
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.38
|
| Rate for Payer: Dean Health Medicaid |
$5.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.38
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare Medicaid |
$5.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$143.25
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WMAP Medicaid |
$5.38
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
BO Antibody Screen
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
975767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
BO Autologous Handling Fee
|
Facility
IP
|
$108.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
973791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$64.80
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
BO Autologous Handling Fee
|
Facility
OP
|
$108.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
973791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$633.08 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$70.20
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
BO Chloroquin Pretreatment
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
975768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$226.72 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
BO Chloroquin Pretreatment
|
Facility
IP
|
$123.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
975768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
